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Spencer Johnson looks back on 30 years of leading Michigan's hospitals

Ask Spencer Johnson, retiring president of the Michigan Health and Hospital Association, about his health care career of more than 44 years and you ultimately will start off with a discussion about Social Security.

Not about whether Social Security should be privatized as some politicians have suggested over the past 20 years, but about when President Roosevelt signed it into law in 1935.

Johnson — who is stepping down June 30, 2015, to make way for Senior Vice President Brian Peters, himself a 25-year association veteran — has a long institutional memory that also extends back to the beginning of Medicare and Medicaid in 1965.

Johnson’s career in health policy actually started in 1970, when he worked as a congressional health staffer for former Rep. James Hastings and Sen. Jacob Javits, R-New York, and later as associate director of the Domestic Council for Health, Social Security and Income Assistance at the White House under President Gerald Ford.

Before he was hired by the Michigan Hospital Association, as it was called until the mid-1990s, he was executive vice president of the Hospital Association of New York State.

“I came here in 1985; it turned into a life sentence,” said Johnson, 70, in typical deadpan fashion.

On his “political” career, Johnson said: “I participated with Ted Kennedy and the House of Representatives in passing the HMO Act (of 1973). He was one of the first to propose a comprehensive health program — Medicare for all.”

Johnson said Kennedy’s discussion of universal health insurance, which he now calls Medicare Part E (as in ‘e’ for everyone), inevitably led to the passage in 2010 of the Patient Protection and Affordable Care Act, or Obamacare.

“This might be the new ‘wild West’ mentality as people, voters and (health care) people providing care try to figure out what happened,” said Johnson, predicting that the next presidential election will stimulate a movement to “fix health care reform.”

While Johnson credits Obamacare with intensifying reform of the health care delivery system that already was underway, he said he would have suggested the president and Congress roll out the changes more slowly.

“(Health reform) is like trying to rebuild your house while it is still burning,” he said.

“Overall, how far can we move, how fast do we go without damaging the financing and the delivery system,” he said. “The expectations have been set very high (for success).”

Adjusting to change

But over the years, the Johnson-led association has worked diligently to help hospitals in Michigan navigate the changing waters of public and private reimbursement, consolidation, physician inclusion, and the movement toward higher quality, better medical outcomes and patient safety.

“The problem all providers have, and it is not just hospitals, is the constant readjusting of the economic impact,” he said. “There will not be as much revenue in the system. This has been the theme the past few years.”

Johnson calls health care in the 21st century “the do-more-with-less era. … This has happened as government has gotten more involved in health policy.”

Over the past several years, Johnson said he has delivered a four-pronged message to hospital executives, physicians, the media, politicians and the public about health care change.

His four messages are: the need to transform the health care delivery system from within; the importance of managing the health of patient populations and coordinate care; the need to better manage reimbursement and develop methods to manage financial risk; and the value of sharing patient data among providers using electronic health records and integrated health information exchanges that link all providers.

“We need to prepare because there will not be the same amount of money in the system for providers and others. We will see more Medicare cuts in the next two to three years,” said Johnson.

Johnson predicted that consolidation of hospitals and physicians into larger organizations is a trend that will continue.

“A small practice can’t afford a $500,000 bill for an electronic health record,” he said. “There will be more consolidation of physicians into bigger groups, and doctors into hospitals.”

For example, American Medical Association data shows that about 65 percent of the state’s 19,000 physicians either work for hospitals or have close affiliation relationships with hospitals.

“It is really important we get access to clinical data to help manage patient care,” he said. “If you show up in an ER or physician office, the ability to pull up your chart, see what quality you have, is very important.”

Achievements

Johnson cited several achievements under his tenure. One was in 1993 when the state enacted medical liability reform that has led to fewer malpractice lawsuits and more stable premium costs.

“When we got that done, that was a significant (help) for providers,” he said.

Another was the creation in 2003 of the MHA Keystone Center.

“My view is if there is no measurement, there is no improvement,” he said. “We found that out with (the Keystone Center) over the last 10 years."

Funded in part by state and federal governments, member hospitals and Blue Cross Blue Shield of Michigan, the Keystone Center has researched and helped hospitals implement a number of clinical care and quality improvement initiatives that have saved thousands of lives.

While Johnson said there are some things he won’t miss as head of the state hospital association — like losing the 2002 state constitutional amendment battle about using 90 percent of tobacco settlement money specifically for health care — there are things he will miss.

“I will miss being on the cutting edge of things” and advocating for hospitals and patients, said Johnson, who said he and his wife, Julianne, will remain in the Lansing area to be close to their three sons and three granddaughters.

“We will stick around. My wife has spent a lifetime being indispensable to them,” he said.